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1. Brain Behav Immun. 2020 Aug;88:901-907. doi: 10.1016/j.bbi.2020.05.026.
Epub
2020 May 8.
Prevalence of depression, anxiety, and insomnia among healthcare workers during
the COVID-19 pandemic: A systematic review and meta-analysis.
Pappa S(1), Ntella V(2), Giannakas T(2), Giannakoulis VG(2), Papoutsi E(2),
Katsaounou P(3).
Author information:
(1)Dept of Psychiatry, Imperial College London, London, United Kingdom; West
London NHS Trust, London, United Kingdom. Electronic address:
sofia.pappa@westlondon.nhs.uk.
(2)National and Kapodistrian University of Athens, Athens, Greece.
(3)National and Kapodistrian University of Athens, Athens, Greece; Pulmonary and
Respiratory Failure Department, First ICU, Evaggelismos Hospital. Athens,
Greece.
Erratum in
Brain Behav Immun. 2021 Feb;92:247.
Comment in
J Occup Environ Med. 2020 Nov;62(11):e677-e678.
Brain Behav Immun. 2021 Feb;92:205-206.
BACKGROUND: COVID-19 pandemic has the potential to significantly affect the
mental health of healthcare workers (HCWs), who stand in the frontline of this
crisis. It is, therefore, an immediate priority to monitor rates of mood, sleep
and other mental health issues in order to understand mediating factors and
inform tailored interventions. The aim of this review is to synthesize and
analyze existing evidence on the prevalence of depression, anxiety and insomnia

among HCWs during the Covid-19 outbreak.
METHODS: A systematic search of literature databases was conducted up to April
17th, 2020. Two reviewers independently assessed full-text articles according to
predefined criteria. Risk of bias for each individual study was assessed and
data pooled using random-effects meta-analyses to estimate the prevalence of
specific mental health problems. The review protocol is registered in PROSPERO
and is available online.
FINDINGS: Thirteen studies were included in the analysis with a combined total
of 33,062 participants. Anxiety was assessed in 12 studies, with a pooled
prevalence of 23·2% and depression in 10 studies, with a prevalence rate of
22·8%. A subgroup analysis revealed gender and occupational differences with
female HCPs and nurses exhibiting higher rates of affective symptoms compared to
male and medical staff respectively. Finally, insomnia prevalence was estimated
at 38·9% across 5 studies.
INTERPRETATION: Early evidence suggests that a considerable proportion of HCWs
experience mood and sleep disturbances during this outbreak, stressing the need
to establish ways to mitigate mental health risks and adjust interventions under
pandemic conditions.
Copyright © 2020 Elsevier Inc. All rights reserved.
DOI: 10.1016/j.bbi.2020.05.026
PMCID: PMC7206431
PMID: 32437915 [Indexed for MEDLINE]
Conflict of interest statement: SP and PK report grants and personal fees
outside the submitted work. VN, TG, VGG, EP have nothing to disclose.
2. Psychiatry Res. 2020 Sep;291:113190. doi: 10.1016/j.psychres.2020.113190. Epub
2020 Jun 7.
The psychological and mental impact of coronavirus disease 2019 (COVID-19) on
medical staff and general public - A systematic review and meta-analysis.
Luo M(1), Guo L(2), Yu M(3), Jiang W(4), Wang H(5).
Author information:
(1)Department of Anesthesiology, The 965(th) Hospital of the Joint Logistic
Support Force of the People's Liberation Army of China, Jilin, 132011 China.
Electronic address: 2861248954@qq.com.
(2)Department of Psychology, 96605 Army Hospital, Jilin, 134001 China.
(3)Department of Ophthalmology, The 965(th) Hospital of the Joint Logistic
(4)Department of Disease Control, The 965(th) Hospital of the Joint Logistic
(5)Department of Anesthesiology, Daping Hospital, Army Medical University,
Chongqing, 400042 China. Electronic address: 710875839@qq.com.
The coronavirus disease 2019 (COVID-19) pandemic has caused enormous
psychological impact worldwide. We conducted a systematic review and
meta-analysis on the psychological and mental impact of COVID-19 among
healthcare workers, the general population, and patients with higher COVID-19
risk published between 1 Nov 2019 to 25 May 2020. We conducted literature
research using Embase, PubMed, Google scholar and WHO COVID-19 databases. Among
the initial search of 9207 studies, 62 studies with 162,639 participants from 17
countries were included in the review. The pooled prevalence of anxiety and
depression was 33% (95% confidence interval: 28%-38%) and 28% (23%-32%),
respectively. The prevalence of anxiety and depression was the highest among
patients with pre-existing conditions and COVID-19 infection (56% [39%-73%] and
55% [48%-62%]), and it was similar between healthcare workers and the general
public. Studies from China, Italy, Turkey, Spain and Iran reported
higher-than-pooled prevalence among healthcare workers and the general public.
Common risk factors included being women, being nurses, having lower
socioeconomic status, having high risks of contracting COVID-19, and social
isolation. Protective factors included having sufficient medical resources,
up-to-date and accurate information, and taking precautionary measures. In
conclusion, psychological interventions targeting high-risk populations with
heavy psychological distress are in urgent need.
Copyright © 2020 Elsevier B.V. All rights reserved.
DOI: 10.1016/j.psychres.2020.113190
PMCID: PMC7276119
Conflict of interest statement: Declaration of Competing Interest None.
3. Rev Esp Salud Publica. 2020 Jul 23;94:e202007088.
[Impact of SARS-CoV-2 (Covid-19) on the mental health of healthcare
professionals: a systematic review.].
[Article in Spanish; Abstract available in Spanish from the publisher]
García-Iglesias JJ(1)(2), Gómez-Salgado J(1)(3), Martín-Pereira J(4),
Fagundo-Rivera J(2)(5), Ayuso-Murillo D(6), Martínez-Riera JR(7), Ruiz-Frutos
C(1)(3).
Author information:
(1)Departamento de Sociología, Trabajo Social y Salud Pública. Universidad de
Huelva. Huelva. España.
(2)Escuela Superior de Salud. Universidade Atlântica. Lisboa. Portugal.
(3)Programa de Posgrado de Seguridad y Salud. Universidad Espíritu Santo.
Guayaquil. Ecuador.
(4)Consorcio de transporte sanitario onubense. Base en Centro de Salud de Isla
Cristina. Huelva. España.
(5)Servicio Andaluz de Salud. Sevilla. España.
(6)Consejo General de Enfermería de España. Madrid. España.
(7)Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e
Historia de la Ciencia. Facultad de Ciencias de la Salud. Universidad de
Alicante. Alicante. España.
BACKGROUND: In times of this global pandemic situation, population's mental
health is compromised, especially in those groups that are at the forefront of
defence against the virus such as healthcare professionals. The objective of
this study was to analyze the impact of the SARS-CoV-2 outbreak on healthcare
professionals' mental health.
METHODS: A systematic review was carried out following the PRISMA format in
Pubmed, Scopus, Web of Science, CINAHL, PsycINFO and ScienceDirect electronic
databases between January and May 2020. Methodological quality was evaluated
using the Joanna Briggs Institute (JBI) critical appraisal tools for
non-randomized studies.
RESULTS: A total of 13 studies were included in this review. Professionals'
mental health and mental functions were compromised, being especially affected
those professionals on the front line of battle against the virus. However,
these stats were below the general population data. Although there is wide
variability of results, medium-high levels of anxiety (26,5%-44,6%), depression
(8,1%-25%), concern and insomnia are detected (23,6%-38%). Paradoxically, stress
levels were below expectations (3,8%-68,3%).
CONCLUSIONS: The mental well-being of health professionals working on the front

line is compromised in times of pandemic by presenting medium-high levels of
anxiety, depression, nervousness and insomnia, and, to a lesser extent, stress.
Publisher: OBJETIVO: Ante una situación de pandemia mundial, la salud mental de
la población se ve comprometida, especialmente en los colectivos que están en
primera línea de defensa contra el virus como son los profesionales sanitarios.
El objetivo de este estudio fue analizar el impacto en la salud mental de los
profesionales sanitarios que prestan atención a pacientes durante el brote de
SARS-CoV-2.
METODOS: Se realizó una revisión sistemática siguiendo el formato PRISMA en las
bases de datos electrónicas Pubmed, Scopus, Web of Science, CINAHL, PsycINFO y
ScienceDirect entre los meses de enero y mayo de 2020. Se evaluó la calidad
metodológica a partir de las herramientas de evaluación crítica para estudios no
randomizados del Joanna Briggs Institute (JBI).
RESULTADOS: Un total de 13 estudios fueron incluidos en esta revisión. La salud
mental de los profesionales sanitarios se vio comprometida ante la pandemia de
SARS-CoV-2 en el ejercicio de sus funciones, siendo especialmente afectados los
profesionales que se encontraban en la primera línea de batalla contra el virus,
pero con valores por debajo de los de la población general. Aunque existió una
amplia variabilidad de resultados, se observaron niveles medio-altos de ansiedad
(26,5%-44,6%), depresión (8,1%-25%), preocupación e insomnio (23,6%-38%), y,
paradójicamente, niveles de estrés por debajo de lo esperado (3,8%-68,3%).
CONCLUSIONES: La salud mental de los profesionales sanitarios que trabajan en
primera línea de batalla se ve comprometida en tiempos de pandemia presentando
niveles medio-altos de ansiedad, depresión, preocupación e insomnio, y, en menor
medida, estrés.
4. Brain Behav Immun. 2020 Oct;89:531-542. doi: 10.1016/j.bbi.2020.05.048. Epub

2020 May 30.
COVID-19 pandemic and mental health consequences: Systematic review of the
current evidence.
Vindegaard N(1), Benros ME(2).
Author information:
(1)Copenhagen Research Centre for Mental Health - CORE, Mental Health Centre
Copenhagen, Copenhagen University Hospital, Gentofte Hospitalsvej 15, 4. sal,
2900 Hellerup, Denmark; Department of Immunology and Microbiology, Faculty of
Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200
Copenhagen N, Denmark.
(2)Copenhagen Research Centre for Mental Health - CORE, Mental Health Centre
Copenhagen, Copenhagen University Hospital, Gentofte Hospitalsvej 15, 4. sal,
2900 Hellerup, Denmark; Department of Immunology and Microbiology, Faculty of
Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200
Copenhagen N, Denmark. Electronic address: Michael.eriksen.benros@regionh.dk.
BACKGROUND: During the COVID-19 pandemic general medical complications have
received the most attention, whereas only few studies address the potential
direct effect on mental health of SARS-CoV-2 and the neurotropic potential.
Furthermore, the indirect effects of the pandemic on general mental health are
of increasing concern, particularly since the SARS-CoV-1 epidemic (2002-2003)
was associated with psychiatric complications.
METHODS: We systematically searched the database Pubmed including studies
measuring psychiatric symptoms or morbidities associated with COVID-19 among
infected patients and among none infected groups the latter divided in
psychiatric patients, health care workers and non-health care workers.
RESULTS: A total of 43 studies were included. Out of these, only two studies
evaluated patients with confirmed COVID-19 infection, whereas 41 evaluated the

indirect effect of the pandemic (2 on patients with preexisting psychiatric
disorders, 20 on medical health care workers, and 19 on the general public). 18
of the studies were case-control studies/compared to norm, while 25 of the
studies had no control groups. The two studies investigating COVID-19 patients
found a high level of post-traumatic stress symptoms (PTSS) (96.2%) and
significantly higher level of depressive symptoms (p = 0.016). Patients with
preexisting psychiatric disorders reported worsening of psychiatric symptoms.
Studies investigating health care workers found increased depression/depressive
symptoms, anxiety, psychological distress and poor sleep quality. Studies of the
general public revealed lower psychological well-being and higher scores of
anxiety and depression compared to before COVID-19, while no difference when
comparing these symptoms in the initial phase of the outbreak to four weeks
later. A variety of factors were associated with higher risk of psychiatric
symptoms and/or low psychological well-being including female gender,
poor-self-related health and relatives with COVID-19.
CONCLUSION: Research evaluating the direct neuropsychiatric consequences and the
indirect effects on mental health is highly needed to improve treatment, mental
health care planning and for preventive measures during potential subsequent
pandemics.
Copyright © 2020 Elsevier Inc. All rights reserved.
DOI: 10.1016/j.bbi.2020.05.048
PMCID: PMC7260522
5. Ann N Y Acad Sci. 2021 Feb;1486(1):90-111. doi: 10.1111/nyas.14506. Epub 2020
Oct 2.
The prevalence of depression, anxiety, and sleep disturbances in COVID-19

patients: a meta-analysis.
Deng J(1), Zhou F(1), Hou W(1), Silver Z(2), Wong CY(1), Chang O(1), Huang E(1),
Zuo QK(3).
Author information:
(1)Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
(2)Faculty of Science, Carleton University, Ottawa, Ontario, Canada.
(3)Department of Anesthesiology, Rutgers New Jersey Medical School, Newark, New
Jersey.
Evidence from previous coronavirus outbreaks has shown that infected patients
are at risk for developing psychiatric and mental health disorders, such as
depression, anxiety, and sleep disturbances. To construct a comprehensive
picture of the mental health status in COVID-19 patients, we conducted a
systematic review and random-effects meta-analysis to assess the prevalence of
depression, anxiety, and sleep disturbances in this population. We searched
MEDLINE, EMBASE, PubMed, Web of Science, CINAHL, Wanfang Data, Wangfang Med
Online, CNKI, and CQVIP for relevant articles, and we included 31 studies
(n = 5153) in our analyses. We found that the pooled prevalence of depression
was 45% (95% CI: 37-54%, I2 = 96%), the pooled prevalence of anxiety was 47%
(95% CI: 37-57%, I2 = 97%), and the pooled prevalence of sleeping disturbances
was 34% (95% CI: 19-50%, I2 = 98%). We did not find any significant differences
in the prevalence estimates between different genders; however, the depression
and anxiety prevalence estimates varied based on different screening tools. More
observational studies assessing the mental wellness of COVID-19 outpatients and
COVID-19 patients from countries other than China are needed to further examine
the psychological implications of COVID-19 infections.
© 2020 New York Academy of Sciences.

DOI: 10.1111/nyas.14506
PMCID: PMC7675607
Conflict of interest statement: The authors declare no competing interests.
6. J Affect Disord. 2020 Dec 1;277:55-64. doi: 10.1016/j.jad.2020.08.001. Epub 2020
Aug 8.
Impact of COVID-19 pandemic on mental health in the general population: A
systematic review.
Xiong J(1), Lipsitz O(2), Nasri F(2), Lui LMW(2), Gill H(2), Phan L(2), Chen-Li
D(2), Iacobucci M(2), Ho R(3), Majeed A(2), McIntyre RS(4).
Author information:
(1)Department of Pharmacology and Toxicology, University of Toronto, Toronto,
ON.
(2)Mood Disorders Psychopharmacology Unit, University Health Network, Toronto,
Ontario.
(3)Department of Psychological Medicine, Yong Loo Lin School of Medicine,
National University of Singapore, Singapore; Institute for Health Innovation and
Technology (iHealthtech), National University of Singapore, Singapore.
(4)Department of Pharmacology and Toxicology, University of Toronto, Toronto,
ON; Department of Psychiatry, University of Toronto, Toronto, Ontario; Mood
Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario;
Brain and Cognition Discovery Foundation, Toronto, ON. Electronic address:
roger.mcintyre@uhn.ca.
BACKGROUND: As a major virus outbreak in the 21st century, the Coronavirus

disease 2019 (COVID-19) pandemic has led to unprecedented hazards to mental
health globally. While psychological support is being provided to patients and
healthcare workers, the general public's mental health requires significant
attention as well. This systematic review aims to synthesize extant literature
that reports on the effects of COVID-19 on psychological outcomes of the general
population and its associated risk factors.
METHODS: A systematic search was conducted on PubMed, Embase, Medline, Web of
Science, and Scopus from inception to 17 May 2020 following the PRISMA
guidelines. A manual search on Google Scholar was performed to identify
additional relevant studies. Articles were selected based on the predetermined
eligibility criteria.
RESULTS: Relatively high rates of symptoms of anxiety (6.33% to 50.9%),
depression (14.6% to 48.3%), post-traumatic stress disorder (7% to 53.8%),
psychological distress (34.43% to 38%), and stress (8.1% to 81.9%) are reported
in the general population during the COVID-19 pandemic in China, Spain, Italy,
Iran, the US, Turkey, Nepal, and Denmark. Risk factors associated with distress
measures include female gender, younger age group (≤40 years), presence of
chronic/psychiatric illnesses, unemployment, student status, and frequent
exposure to social media/news concerning COVID-19.
LIMITATIONS: A significant degree of heterogeneity was noted across studies.
CONCLUSIONS: The COVID-19 pandemic is associated with highly significant levels
of psychological distress that, in many cases, would meet the threshold for
clinical relevance. Mitigating the hazardous effects of COVID-19 on mental
health is an international public health priority.
Copyright © 2020. Published by Elsevier B.V.
DOI: 10.1016/j.jad.2020.08.001
PMCID: PMC7413844

Conflict of interest statement: None
7. Med Clin (Barc). 2021 May 7;156(9):449-458. doi: 10.1016/j.medcli.2020.11.009.
Epub 2021 Jan 1.
Psychological impact of COVID-19 pandemic in Western frontline healthcare
professionals. A systematic review.
[Article in English, Spanish]
Danet Danet A(1).
Author information:
(1)Departamento de Sociología, Facultad de Ciencias Políticas y Sociología,
Universidad de Granada, Granada, España. Electronic address: adanet@ugr.es.
The aim of this study was to assess the psychological impact among healthcare
workers who stand in the frontline of the SARS-CoV-2 crisis and to compare it
with the rest of healthcare professionals, by means of a systematic review of
Western publications. The systematic review was carried out in PubMed, Scopus
and Web of Science databases and 12 descriptive studies were reviewed. The
European and American quantitative studies reported moderate and high levels of
stress, anxiety, depression, sleep disturbance and burnout, with diverse coping
strategies and more frequent and intense symptoms among women and nurses,
without conclusive results by age. In the first line of assistance the
psychological impact was greater than in the rest of the health professionals
and in the Asian area. It is necessary to go deeper into the emotional
experiences and professional needs for emotional support in order to design
effective interventions for protection and help.

The aim of this study was to assess the psychological impact among healthcare
workers who stand in the frontline of the SARS-CoV-2 crisis and to compare it
with the rest of healthcare professionals, by means of a systematic review of
Western publications. The systematic review was carried out in PubMed, Scopus
and Web of Science databases and 12 descriptive studies were reviewed. The
European and American quantitative studies reported moderate and high levels of
stress, anxiety, depression, sleep disturbance and burnout, with diverse coping
strategies and more frequent and intense symptoms among women and nurses,
without conclusive results by age. In the first line of assistance the
psychological impact was greater than in the rest of the health professionals
and in the Asian area. It is necessary to go deeper into the emotional
experiences and professional needs for emotional support in order to design
effective interventions for protection and help.
Copyright © 2020 Elsevier España, S.L.U. All rights reserved.
DOI: 10.1016/j.medcli.2020.11.009
PMCID: PMC7775650
8. J Rehabil Med. 2020 May 31;52(5):jrm00063. doi: 10.2340/16501977-2694.
Long-term clinical outcomes in survivors of severe acute respiratory syndrome
and Middle East respiratory syndrome coronavirus outbreaks after hospitalisation
or ICU admission: A systematic review and meta-analysis.
Ahmed H(1), Patel K(1), Greenwood DC(2), Halpin S(3), Lewthwaite P(4), Salawu
A(5), Eyre L(6), Breen A(6), O'Connor R(3), Jones A(7), Sivan M(3).
Author information:
(1)School of Medical Sciences, University of Manchester, UK.
(2)School of Medicine and Leeds Institute for Data Analytics, University of
Leeds, UK
(3)Academic Department of Rehabilitation Medicine, University of Leeds and
National Demonstration Centre of Rehabilitation Medicine, Leeds Teaching
Hospitals NHS trust, UK
(4)Department of Infectious Diseases, Leeds Teaching Hospitals NHS Trust, Leeds,
UK
(5)Department of Rehabilitation Medicine, Hull University Teaching Hospitals NHS
Trust, Hull, UK
(6)Intensive Care Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
(7)Division of Neuroscience and Experimental Psychology, University of
Manchester, Manchester, UK
OBJECTIVE: To determine long-term clinical outcomes in survivors of severe acute
respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS)
coronavirus infections after hospitalization or intensive care unit admission.
DATA SOURCES: Ovid MEDLINE, EMBASE, CINAHL Plus, and PsycINFO were searched.
STUDY SELECTION: Original studies reporting clinical outcomes of adult SARS and
MERS survivors 3 months after admission or 2 months after discharge were
included.
DATA EXTRACTION: Studies were graded using the Oxford Centre for Evidence-Based
Medicine 2009 Level of Evidence Tool. Meta-analysis was used to derive pooled
estimates for prevalence/severity of outcomes up to 6 months after hospital
discharge, and beyond 6 months after discharge.
DATA SYNTHESIS: Of 1,169 identified studies, 28 were included in the analysis.
Pooled analysis revealed that common complications up to 6 months after
discharge were: impaired diffusing capacity for carbon monoxide (prevalence 27%,
95% confidence interval (CI) 15–45%); and reduced exercise capacity (mean 6-min
walking distance 461 m, CI 450–473 m). The prevalences of post-traumatic stress
disorder (39%, 95% CI 31–47%), depression (33%, 95% CI 20–50%) and anxiety (30%,
95% CI 10–61) beyond 6 months after discharge were considerable. Low scores on
Short-Form 36 were identified beyond 6 months after discharge.
CONCLUSION: Lung function abnormalities, psychological impairment and reduced
exercise capacity were common in SARS and MERS survivors. Clinicians should
anticipate and investigate similar long-term outcomes in COVID-19 survivors.
DOI: 10.2340/16501977-2694
9. Hum Resour Health. 2020 Dec 17;18(1):100. doi: 10.1186/s12960-020-00544-1.
The prevalence of stress, anxiety and depression within front-line healthcare
workers caring for COVID-19 patients: a systematic review and meta-regression.
Salari N(1)(2), Khazaie H(2), Hosseinian-Far A(3), Khaledi-Paveh B(2), Kazeminia
M(4), Mohammadi M(5), Shohaimi S(6), Daneshkhah A(7), Eskandari S(2).
Author information:
(1)Department of Biostatistics, School of Health, Kermanshah University of
Medical Sciences, Kermanshah, Iran.
(2)Sleep Disorders Research Center, Kermanshah University of Medical Sciences,
Kermanshah, Iran.
(3)Department of Business Systems & Operations, University of Northampton,
Northampton, UK.
(4)Department of Nursing, School of Nursing and Midwifery, Kermanshah University
of Medical Sciences, Kermanshah, Iran. mohsenkaz221@gmail.com.
(5)Department of Nursing, School of Nursing and Midwifery, Kermanshah University
of Medical Sciences, Kermanshah, Iran. Masoud.mohammadi1989@yahoo.com.
(6)Department of Biology, Faculty of Science, University Putra Malaysia,
Serdang, Selangor, Malaysia.

(7)School of Computing, Electronics and Maths, Coventry University, London, UK.
BACKGROUND: Stress, anxiety, and depression are some of the most important
research and practice challenges for psychologists, psychiatrists, and
behavioral scientists. Due to the importance of issue and the lack of general
statistics on these disorders among the Hospital staff treating the COVID-19
patients, this study aims to systematically review and determine the prevalence
of stress, anxiety and depression within front-line healthcare workers caring
for COVID-19 patients.
METHODS: In this research work, the systematic review, meta-analysis and
meta-regression approaches are used to approximate the prevalence of stress,
anxiety and depression within front-line healthcare workers caring for COVID-19
patients. The keywords of prevalence, anxiety, stress, depression, psychopathy,
mental illness, mental disorder, doctor, physician, nurse, hospital staff,
2019-nCoV, COVID-19, SARS-CoV-2 and Coronaviruses were used for searching the
SID, MagIran, IranMedex, IranDoc, ScienceDirect, Embase, Scopus, PubMed, Web of
Science (ISI) and Google Scholar databases. The search process was conducted in
December 2019 to June 2020. In order to amalgamate and analyze the reported
results within the collected studies, the random effects model is used. The
heterogeneity of the studies is assessed using the I2 index. Lastly, the data
analysis is performed within the Comprehensive Meta-Analysis software.
RESULTS: Of the 29 studies with a total sample size of 22,380, 21 papers have
reported the prevalence of depression, 23 have reported the prevalence of
anxiety, and 9 studies have reported the prevalence of stress. The prevalence of
depression is 24.3% (18% CI 18.2-31.6%), the prevalence of anxiety is 25.8% (95%
CI 20.5-31.9%), and the prevalence of stress is 45% (95% CI 24.3-67.5%) among
the hospitals' Hospital staff caring for the COVID-19 patients. According to the
results of meta-regression analysis, with increasing the sample size, the
prevalence of depression and anxiety decreased, and this was statistically
significant (P < 0.05), however, the prevalence of stress increased with
increasing the sample size, yet this was not statistically significant
(P = 0.829).
CONCLUSION: The results of this study clearly demonstrate that the prevalence of
stress, anxiety and depression within front-line healthcare workers caring for
COVID-19 patients is high. Therefore, the health policy-makers should take
measures to control and prevent mental disorders in the Hospital staff.
DOI: 10.1186/s12960-020-00544-1
PMCID: PMC7745176
Conflict of interest statement: The authors declare that they have no conflict
of interest.
10. Int J Environ Res Public Health. 2020 Nov 16;17(22):8479. doi:
10.3390/ijerph17228479.
Exploring the Impact of COVID-19 on Mental Health Outcomes in Children and
Adolescents: A Systematic Review.
Nearchou F(1), Flinn C(1), Niland R(1), Subramaniam SS(2), Hennessy E(1).
Author information:
(1)School of Psychology, University College Dublin, 4 Dublin, Ireland.
(2)School of Medicine, University College Dublin, 4 Dublin, Ireland.
The psychological impact of the COVID-19 pandemic has been widely discussed
during the past few months, with scholars expressing concern about its potential
debilitating consequences on youth mental health. Hence, this research aimed to
provide a systematic review of the evidence on the COVID-19 pandemic's impact on
youth mental health. We conducted a mixed methods integrated review to identify

any empirical study that focused on young people ≤ 18 years old. Eight databases
were systematically searched to identify studies of any type of research design.
The selection procedure followed the Preferred Reporting Items for Systematic
Review and Meta-Analyses (PRISMA) guidelines. The protocol of this systematic
review was registered with PROSPERO (protocol ID: CRD4202019375). Twelve studies
deemed eligible for data extraction (n = 12,262). The findings show that
COVID-19 has an impact on youth mental health and is particularly associated
with depression and anxiety in adolescent cohorts. The quality appraisal
indicated that all studies were of low or moderate methodological quality. The
COVID-19 pandemic is affecting young people's lives, and thus generating robust
research evidence to inform policy decisions is essential. Hence, the
methodological quality of future research should be drastically improved.
DOI: 10.3390/ijerph17228479
PMCID: PMC7698263
Conflict of interest statement: The authors declare no conflict of interest.
11. Cochrane Database Syst Rev. 2020 May 21;5(5):CD013632. doi:
10.1002/14651858.CD013632.
Video calls for reducing social isolation and loneliness in older people: a
rapid review.
Noone C(1), McSharry J(1), Smalle M(2), Burns A(3), Dwan K(4), Devane D(5),
Morrissey EC(6).
Author information:
(1)School of Psychology, National University of Ireland Galway, Galway, Ireland.

(2)James Hardiman Library, National University of Ireland Galway, Galway,
Ireland.
(3)Institute of Public Health in Ireland, Dublin 8, Ireland.
(4)Review Production and Quality Unit, Editorial & Methods Department, Cochrane
Central Executive, London, UK.
(5)School of Nursing and Midwifery, National University of Ireland Galway,
Galway, Ireland.
(6)School of Medicine, National University of Ireland Galway, Galway, Ireland.
BACKGROUND: The current COVID-19 pandemic has been identified as a possible
trigger for increases in loneliness and social isolation among older people due
to the restrictions on movement that many countries have put in place.
Loneliness and social isolation are consistently identified as risk factors for
poor mental and physical health in older people. Video calls may help older
people stay connected during the current crisis by widening the participant's
social circle or by increasing the frequency of contact with existing
acquaintances.
OBJECTIVES: The primary objective of this rapid review is to assess the
effectiveness of video calls for reducing social isolation and loneliness in
older adults. The review also sought to address the effectiveness of video calls
on reducing symptoms of depression and improving quality of life.
SEARCH METHODS: We searched CENTRAL, MEDLINE, PsycINFO and CINAHL from 1 January
2004 to 7 April 2020. We also searched the references of relevant systematic
reviews.
SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs
(including cluster designs) were eligible for inclusion. We excluded all other
study designs. The samples in included studies needed to have a mean age of at
least 65 years. We included studies that included participants whether or not
they were experiencing symptoms of loneliness or social isolation at
baseline. Any intervention in which a core component involved the use of the
internet to facilitate video calls or video conferencing through computers,

smartphones or tablets with the intention of reducing loneliness or social
isolation, or both, in older adults was eligible for inclusion. We included
studies in the review if they reported self-report measures of loneliness,
social isolation, symptoms of depression or quality of life. Two review authors
screened 25% of abstracts; a third review author resolved conflicts. A single
review author screened the remaining abstracts. The second review author
screened all excluded abstracts and we resolved conflicts by consensus or by
involving a third review author. We followed the same process for full-text
articles.
DATA COLLECTION AND ANALYSIS: One review author extracted data, which another
review author checked. The primary outcomes were loneliness and social isolation
and the secondary outcomes were symptoms of depression and quality of life. One
review author rated the certainty of evidence for the primary outcomes according
to the GRADE approach and another review author checked the ratings. We
conducted fixed-effect meta-analyses for the primary outcome, loneliness, and
the secondary outcome, symptoms of depression.
MAIN RESULTS: We identified three cluster quasi-randomised trials, which
together included 201 participants. The included studies compared video call
interventions to usual care in nursing homes. None of these studies were
conducted during the COVID-19 pandemic. Each study measured loneliness using
the UCLA Loneliness Scale. Total scores range from 20 (least lonely) to 80 (most
lonely). The evidence was very uncertain and suggests that video calls may
result in little to no difference in scores on the UCLA Loneliness Scale
compared to usual care at three months (mean difference (MD) -0.44, 95%
confidence interval (CI) -3.28 to 2.41; 3 studies; 201 participants), at six
months (MD -0.34, 95% CI -3.41 to 2.72; 2 studies; 152 participants) and at 12
months (MD -2.40, 95% CI -7.20 to 2.40; 1 study; 90 participants). We downgraded
the certainty of this evidence by three levels for study limitations,
imprecision and indirectness. None of the included studies reported social
isolation as an outcome. Each study measured symptoms of depression using the
Geriatric Depression Scale. Total scores range from 0 (better) to 30 (worse).

The evidence was very uncertain and suggests that video calls may result in
little to no difference in scores on the Geriatric Depression Scale compared to
usual care at three months' follow-up (MD 0.41, 95% CI -0.90 to 1.72; 3 studies;
201 participants) or six months' follow-up (MD -0.83, 95% CI -2.43 to 0.76; 2
studies, 152 participants). The evidence suggests that video calls may have a
small effect on symptoms of depression at one-year follow-up, though this
finding is imprecise (MD -2.04, 95% CI -3.98 to -0.10; 1 study; 90
participants). We downgraded the certainty of this evidence by three levels for
study limitations, imprecision and indirectness. Only one study, with 62
participants, reported quality of life. The study measured quality of life using
a Taiwanese adaptation of the Short-Form 36-question health survey (SF-36),
which consists of eight subscales that measure different aspects of quality of
life: physical function; physical role; emotional role; social function; pain:
vitality; mental health; and physical health. Each subscale is scored from 0
(poor health) to 100 (good health). The evidence is very uncertain and suggests
that there may be little to no difference between people allocated to usual care
and those allocated to video calls in three-month scores in physical function
(MD 2.88, 95% CI -5.01 to 10.77), physical role (MD -7.66, 95% CI -24.08 to
8.76), emotional role (MD -7.18, 95% CI -16.23 to 1.87), social function (MD
2.77, 95% CI -8.87 to 14.41), pain scores (MD -3.25, 95% CI -15.11 to 8.61),
vitality scores (MD -3.60, 95% CI -9.01 to 1.81), mental health (MD 9.19, 95% CI
0.36 to 18.02) and physical health (MD 5.16, 95% CI -2.48 to 12.80). We
downgraded the certainty of this evidence by three levels for study limitations,
imprecision and indirectness.
AUTHORS' CONCLUSIONS: Based on this review there is currently very uncertain
evidence on the effectiveness of video call interventions to reduce loneliness
in older adults. The review did not include any studies that reported evidence
of the effectiveness of video call interventions to address social isolation in
older adults. The evidence regarding the effectiveness of video calls for
outcomes of symptoms of depression was very uncertain. Future research in this
area needs to use more rigorous methods and more diverse and representative
participants. Specifically, future studies should target older adults, who are
demonstrably lonely or socially isolated, or both, across a range of settings to
determine whether video call interventions are effective in a population in
which these outcomes are in need of improvement.
Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons,
Ltd.
DOI: 10.1002/14651858.CD013632
PMCID: PMC7387868
Conflict of interest statement: Noone C: noneMc Sharry J: noneSmalle M:
noneBurns A: noneDwan K: noneDevane D: noneMorrissey E: none
12. Psychiatry Res. 2020 Nov;293:113382. doi: 10.1016/j.psychres.2020.113382. Epub
2020 Aug 11.
Prevalence of psychological morbidities among general population, healthcare
workers and COVID-19 patients amidst the COVID-19 pandemic: A systematic review
and meta-analysis.
Krishnamoorthy Y(1), Nagarajan R(2), Saya GK(2), Menon V(3).
Author information:
(1)Department of Preventive and Social Medicine, Jawaharlal Institute of
Postgraduate Medical Education and Research (JIPMER), Puducherry 605006, India.
Electronic address: yuvi.1130@gmail.com.
(2)Department of Preventive and Social Medicine, Jawaharlal Institute of
Postgraduate Medical Education and Research (JIPMER), Puducherry 605006, India.

(3)Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical
Education and Research (JIPMER), Puducherry 605006, India.
This review was done to synthesize the existing evidence on the prevalence of
various psychological morbidities among general public, healthcare workers and
COVID-19 patients amidst this pandemic situation. Systematic searches were
conducted in various databases and search engines such as Medline, Chinese
national knowledge infrastructure, Cochrane library, ScienceDirect, and Google
Scholar from inception until 22 April 2020. Newcastle Ottawa scale was used to
assess the quality of included studies. We carried out a meta-analysis with
random-effects model and reported pooled prevalence with 95% confidence
intervals (CIs).A total of 50 studies were included in the review. Only seven
studies (14%) had low risk of bias. Pooled prevalence rate of psychological
morbidities includes poor sleep quality (40%), stress (34%), psychological
distress (34%), insomnia (30%), post-traumatic stress symptoms (27%), anxiety
(26%), depression (26%). Pooled prevalence rate of psychological morbidities
with respect to impact of event due to COVID-19 pandemic was 44% (95%CI-42% to
47%). The burden of these psychological morbidities was highest among the
COVID-19 patients followed by healthcare workers and general population.
DOI: 10.1016/j.psychres.2020.113382
PMCID: PMC7417292
Conflict of interest statement: None declared
13. Asian J Psychiatr. 2021 Feb;56:102533. doi: 10.1016/j.ajp.2020.102533. Epub 2020
Dec 28.
Psychological effects caused by COVID-19 pandemic on pregnant women: A
systematic review with meta-analysis.
Fan S(1), Guan J(2), Cao L(2), Wang M(2), Zhao H(2), Chen L(3), Yan L(4).
Author information:
(1)School of Medicine, Cheeloo College of Medicine, Shandong University, Jinan,
Shandong, China.
(2)The Eighth People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi,
Xinjiang Uygur Autonomous Region, China.
(3)The Eighth People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi,
Xinjiang Uygur Autonomous Region, China; Chen Lili's Clinic, Korla, Bayingolin
Mongol Autonomous State, Xinjiang Uygur Autonomous Region, China. Electronic
address: 18910931311@163.com.
(4)School of Medicine, Cheeloo College of Medicine, Shandong University, Jinan,
Shandong, China; The Eighth People's Hospital of Xinjiang Uygur Autonomous
Region, Urumqi, Xinjiang Uygur Autonomous Region, China. Electronic address:
yanlei@sdu.edu.cn.
AIM: This study aimed to investigate and monitor the mental health status of
pregnant women during the COVID-19 pandemic.
MATERIALS AND METHODS: The meta-analysis was used to study the literatures on
the psychology of pregnant women in four databases until Sep 27, 2020.
RESULTS: A total of 19 articles were included in the final meta-analysis. The
overall prevalence of anxiety was 42 % (95 %CI 26 %-57 %) with substantial
heterogeneity (I2 = 99.6 %). The overall prevalence of depression was 25 % (95
%CI 20 %-31 %) with substantial heterogeneity (I2 = 97.9 %). Age, family
economic status, social support, and physical activity seem to correlate with
the mental health status of pregnant women.
CONCLUSION: The prevalence of anxiety and depression among pregnant women

increased significantly during the COVID-19 epidemic. Pregnant women are more
concerned about others than themselves during COVID-19, and younger pregnant
women seem to be more prone to anxiety, while social support and physical
activity can reduce the likelihood of anxiety and depression. It is necessary to
take some psychological intervention measures for pregnant women to help them go
through this special period safely and smoothly.
DOI: 10.1016/j.ajp.2020.102533
PMCID: PMC7833174
Conflict of interest statement: The authors report no declarations of interest.
14. Medicine (Baltimore). 2020 Dec 11;99(50):e23298. doi:
10.1097/MD.0000000000023298.
Media and scientific communication about the COVID-19 pandemic and the
repercussions on the population's mental health: A protocol for a systematic
review and meta-analysis.
Pimenta IDSF(1), de Sousa Mata ÁN(2), Braga LP(2), de Medeiros GCBS(3), de
Azevedo KPM(1), Bezerra INM(4), de Oliveira Segundo VH(1), de França Nunes
AC(1), Santos GM(5), Grosseman S(6), Nicolás IM(7), Piuvezam G(8).
Author information:
(1)Department of Odontology, Post-Graduation Program in Public Health, Federal
University of Rio Grande do Norte, Natal/RN.
(2)Multicampi School of Medical Sciences of Rio Grande do Norte, Federal

University of Rio Grande do Norte, Caicó/RN.
(3)Department of Nutrition, Federal University of Rio Grande do Norte, Natal/RN.
(4)Vitoria Academic Center, Federal University of Pernambuco, Vitoria/PE.
(5)Department of Administrative Sciences, Federal University of Santa Maria,
Santa Maria/RS.
(6)Department of Paediatrics, Federal University of Santa Catarina,
Florianopolis/SC, Brazil.
(7)Department of Health Sciences, Catholic University San Antonio de Murcia,
Murcia, Spain.
(8)Department of Public Health, Federal University of Rio Grande do Norte,
Natal/RN, Brazil.
BACKGROUND: Good communication strategies are essential in times of crisis, such
as the coronavirus pandemic. The dissemination of inaccurate information and the
need for social isolation to control coronavirus disease 2019 (COVID-19) have
shown a negative impact on the population, causing damage to mental health, with
the appearance or worsening of symptoms of stress, fear, anxiety, and
depression. Thus, the systematic review study is intended to gather evidence on
the impact of information about COVID-19 on the mental health of the population.
METHODS: This systematic review protocol is conducted using the guidelines of
the preferred reporting items for systematic reviews and meta-analyses protocols
and the Cochrane Handbook for Systematic Reviews of Interventions. The review
aims to include published studies that address the exposure of the general
population to information about COVID-19, through observational and experimental
studies, which consider the following outcomes: fear, stress, anxiety, and
depression. Thus, a comprehensive research strategy will be conducted in the
following databases: PubMed / Medline, Scopus, Web of Science, EMBASE, Science
Direct, CINAHL, PsycINFO and Cochrane Central Register of Controlled Trials
(CENTRAL). Two independent reviewers will perform all procedures, such as study
selection, data collection, and methodological evaluation. Disagreements will be
forwarded to a third reviewer. RevMan 5.3 software will be used for data
analysis.
RESULTS: This systematic review will provide evidence of the influence of access
to and consumption of media and scientific information about COVID-19 on the
mental health of the population. It will consider information about the
characterization of the study and the population studied, clinical and
epidemiological information on mental health, and data on access to and
consumption of media and scientific information.
DISCUSSION: The results should inform about the consequences of communication
about the new coronavirus on the emergence or worsening of psychological and
psychiatric symptoms, allowing to develop strategies to achieve effective
communication of information to promote the mental health of the population.
SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020182918.
DOI: 10.1097/MD.0000000000023298
PMCID: PMC7738065
Conflict of interest statement: The authors have no conflicts of interest to
disclose.
15. Global Health. 2021 Mar 29;17(1):34. doi: 10.1186/s12992-021-00670-y.
Mental burden and its risk and protective factors during the early phase of the
SARS-CoV-2 pandemic: systematic review and meta-analyses.
Kunzler AM(#)(1)(2), Röthke N(#)(3), Günthner L(4), Stoffers-Winterling J(3)(4),
Tüscher O(3)(4), Coenen M(5)(6), Rehfuess E(5)(6), Schwarzer G(7), Binder H(7),
Schmucker C(8), Meerpohl JJ(8)(9), Lieb K(10)(11).
Author information:
(1)Department of Psychiatry and Psychotherapy, University Medical Center of the
Johannes Gutenberg University Mainz, Mainz, Germany.
angela.kunzler@lir-mainz.de.
(2)Leibniz Institute for Resilience Research (LIR), Mainz, Germany.
angela.kunzler@lir-mainz.de.
(5)Institute for Medical Information Processing, Biometry and Epidemiology,
Chair of Public Health and Health Services Research, LMU Munich, Munich,
Germany.
(6)Pettenkofer School of Public Health Munich, Munich, Germany.
(7)Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical
Center, University of Freiburg, Freiburg, Germany.
(8)Institute for Evidence in Medicine, Medical Center - University of Freiburg,
Faculty of Medicine, University of Freiburg, Freiburg, Germany.
(9)Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany.
klaus.lieb@unimedizin-mainz.de.
klaus.lieb@unimedizin-mainz.de.
(#)Contributed equally
BACKGROUND: Mental burden due to the SARS-CoV-2 pandemic has been widely
reported for the general public and specific risk groups like healthcare workers
and different patient populations. We aimed to assess its impact on mental
health during the early phase by comparing pandemic with prepandemic data and to
identify potential risk and protective factors.
METHODS: For this systematic review and meta-analyses, we systematically
searched PubMed, PsycINFO, and Web of Science from January 1, 2019 to May 29,
2020, and screened reference lists of included studies. In addition, we searched
PubMed and PsycINFO for prepandemic comparative data. Survey studies assessing
mental burden by the SARS-CoV-2 pandemic in the general population, healthcare
workers, or any patients (eg, COVID-19 patients), with a broad range of eligible
mental health outcomes, and matching studies evaluating prepandemic comparative
data in the same population (if available) were included. We used multilevel
meta-analyses for main, subgroup, and sensitivity analyses, focusing on
(perceived) stress, symptoms of anxiety and depression, and sleep-related
symptoms as primary outcomes.
RESULTS: Of 2429 records retrieved, 104 were included in the review (n = 208,261
participants), 43 in the meta-analysis (n = 71,613 participants). While symptoms
of anxiety (standardized mean difference [SMD] 0.40; 95% CI 0.15-0.65) and
depression (SMD 0.67; 95% CI 0.07-1.27) were increased in the general population
during the early phase of the pandemic compared with prepandemic conditions,
mental burden was not increased in patients as well as healthcare workers,
irrespective of COVID-19 patient contact. Specific outcome measures (eg, Patient
Health Questionnaire) and older comparative data (published ≥5 years ago) were
associated with increased mental burden. Across the three population groups,
existing mental disorders, female sex, and concerns about getting infected were
repeatedly reported as risk factors, while older age, a good economic situation,
and education were protective.
CONCLUSIONS: This meta-analysis paints a more differentiated picture of the
mental health consequences in pandemic situations than previous reviews.
High-quality, representative surveys, high granular longitudinal studies, and
more research on protective factors are required to better understand the
psychological impacts of the SARS-CoV-2 pandemic and to help design effective
preventive measures and interventions that are tailored to the needs of specific
population groups.
DOI: 10.1186/s12992-021-00670-y
PMCID: PMC8006628
Conflict of interest statement: LG, JSW, and GS have no conflicts of interest to
disclose. AMK, NR, OT, MC, ER, HB, CS, JJM, and KL report grants from the
Federal Ministry of Education and Research (BMBF), Germany, during the conduct
of the study. JJM reports grants from the Federal Ministry of Health (BMG),
Germany, outside of the submitted work.
16. Front Public Health. 2021 Jul 7;9:613321. doi: 10.3389/fpubh.2021.613321.
eCollection 2021.
Depression and Coping Styles of College Students in China During COVID-19
Pandemic: A Systemic Review and Meta-Analysis.
Guo S(1), Kaminga AC(2), Xiong J(3).
Author information:
(1)Department of Economics and Management, Changsha University, Changsha, China.
(2)Department of Mathematics and Statistics, Mzuzu University, Mzuzu, Malawi.
(3)Department of Mathematics and Computer Science, Changsha University,
Changsha, China.
Background: The rapid spread and uncertain outcome of the 2019 novel coronavirus
disease (COVID-19) around the world have caused worry, fear, and stress among
the general population. Nevertheless, the prevalence of depression among college
students in China during lockdown, following the COVID-19 pandemic, and their
coping strategies have not been quantitatively assessed. Objective: We aimed to
evaluate the prevalence of depression among college students in China during the
lockdown due to the COVID-19 pandemic and assess their coping strategies.
Methods: Systematic review and meta-analysis were conducted to assess the

prevalence of depression among college students in China and their coping
strategies. Results: The results indicated that, during lockdown in the COVID-19
pandemic, the prevalence rates of college students in China suffering from mild,
moderate, and severe depression were 25% (95% CI = 17-33%), 7% (95% CI = 2-14%),
and 2% (95% CI = 1-5%), respectively. Besides, the proportion of college
students who use WeChat and Weibo to acquire COVID-19 knowledge was 39% (95% CI
= 13-68%), whereas the proportion of college students using mental health
application services (APPs) to deal with depression was 59% (95% CI = 41-73%).
Conclusions: The prevalence of depression among college students in China was
high during the lockdown in the COVID-19 pandemic. Thus, considering the adverse
outcomes of depression, it is imperative to screen college students in China for
depression during the CIVID-19 pandemic and provide them with necessary
psychological interventions to control and prevent depression. Social media
platforms, such as WeChat and Weibo, and mental health APPs could provide an
opportunity for psychological health information dissemination for college
students. However, their effectiveness in reducing depression will have to be
assessed.
Copyright © 2021 Guo, Kaminga and Xiong.
DOI: 10.3389/fpubh.2021.613321
PMCID: PMC8292621
Conflict of interest statement: The authors declare that the research was
conducted in the absence of any commercial or financial relationships that could
be construed as a potential conflict of interest.
17. Front Public Health. 2021 Aug 17;9:697642. doi: 10.3389/fpubh.2021.697642.
eCollection 2021.
Anxiety and Depression in Chinese Students During the COVID-19 Pandemic: A
Meta-Analysis.
Zhang Y(1), Bao X(1), Yan J(2), Miao H(1), Guo C(1).
Author information:
(1)Department of Psychology, Southwest University, Chongqing, China.
(2)Department of Medcine, Yan'an University, Yan'an, China.
Background: The novel 2019 coronavirus disease (COVID-19) pandemic has spread
rapidly worldwide and poses a global health threat. Aims: This study assessed
the prevalence of anxiety and depression symptoms in Chinese students during the
COVID-19 pandemic and explored potential moderating factors. Methods: We
searched English and Chinese databases using pertinent keywords for articles
published and unpublished, up until November 2020. The estimate of the overall
prevalence of anxiety and depression was conducted through a random-effects
model. Results: A total of 31 cross-sectional studies were included. The overall
prevalence of anxiety and depression symptoms in Chinese students during the
COVID-19 pandemic was 24.0% (95% CI [20.0-29.0%]) and 22.0% (95% CI
[18.0-27.0%]) respectively. Subgroup analyses revealed that Chinese middle
school students were at heightened risk of anxiety, while university students
were at heightened risk of depression. Students who lived in higher-risk areas
presented severe anxiety and depression, especially during the late period of
the COVID-19 epidemic. Conclusions: Overall, during the COVID-19 pandemic, there
was a high prevalence of anxiety in Chinese students and a high prevalence of
depression among Chinese students in high-risk areas. Therefore, comprehensive
and targeted psychological interventions should be developed to address the
mental health of students in different grades, especially in high-risk areas and
during the late period of the COVID-19 pandemic.

Copyright © 2021 Zhang, Bao, Yan, Miao and Guo.
DOI: 10.3389/fpubh.2021.697642
PMCID: PMC8416059
Conflict of interest statement: The authors declare that the research was
conducted in the absence of any commercial or financial relationships that could
be construed as a potential conflict of interest.
18. J Gastrointest Cancer. 2021 Jun;52(2):499-507. doi: 10.1007/s12029-021-00643-9.
Epub 2021 May 5.
Depression and Anxiety Among Patients with Cancer During COVID-19 Pandemic: A
Systematic Review and Meta-analysis.
Ayubi E(1)(2)(3), Bashirian S(4), Khazaei S(5)(6)(7).
Author information:
(1)Infectious Diseases and Tropical Medicine Research Center, Resistant
Tuberculosis Institute, Zahedan University of Medical Sciences, Zahedan, Iran.
(2)Health Promotion Research Center, Zahedan University of Medical Sciences,
Zahedan, Iran.
(3)Department of Community Medicine, School of Medicine, Zahedan University of
Medical Sciences, Zahedan, Iran.
(4)Social Determinants of Health Research Center, Hamadan University of Medical
Sciences, Hamadan, Iran.
(5)Modeling of Non-communicable Diseases Research Canter, Hamadan University of
Medical Sciences, Hamadan, Iran. salman.khazaei61@gmail.com.
(6)Behavioral Disorders and Substance Abuse Research Center, Hamadan University

of Medical Sciences, Hamadan, Iran. salman.khazaei61@gmail.com.
(7)Autism Spectrum Disorders Research Center, Hamadan University of Medical
Sciences, Hamadan, Iran. salman.khazaei61@gmail.com.
BACKGROUND: Investigations about the impact and consequences of the COVID-19
infection on the mental health of patients with chronic diseases and those with
immunosuppressive conditions are growing. The current study aimed to
systematically review and meta-analysis of studies that evaluated the level of
depression and anxiety in cancer patients during the COVID-19 pandemic.
METHODS: The PubMed, Scopus and Web of Sciences databases were searched to
retrieve potential studies from January 2020 to 3 January 2021. Summary data on
frequency and mean of depression and anxiety were extracted. Random-effect
meta-analysis was conducted to estimate overall prevalence, mean and
standardized mean difference.
RESULTS: Thirty-four studies were included in the systematic review, of them 21
studies included in meta-analysis. Overall depression and anxiety were 0.37
(0.27, 0.47); I2 = 99.05%, P value < 0.001 and 0.38 (0.31, 0.46); I2 = 99.08%, P
value < 0.001, respectively. Compared to controls, cancer patients had higher
anxiety level [standard mean difference (SMD 0.25 (95% CI 0.08, 0.42)].
CONCLUSION: Overall, the findings of this study suggest that the prevalence of
depression and anxiety among patients with cancer during the COVID-19 pandemic
can reach considerable levels, although observed substantial heterogeneity
should be considered when interpreting the results.
DOI: 10.1007/s12029-021-00643-9
PMCID: PMC8096890
19. J Affect Disord. 2021 May 15;287:145-157. doi: 10.1016/j.jad.2021.03.016. Epub
2021 Mar 11.

The prevalence of psychiatric comorbidities during the SARS and COVID-19
epidemics: a systematic review and meta-analysis of observational studies.
Zhao YJ(1), Jin Y(2), Rao WW(1), Li W(1), Zhao N(3), Cheung T(4), Ng CH(5), Wang
YY(6), Zhang QE(7), Xiang YT(8).
Author information:
(1)Unit of Psychiatry, Department of Public Health and Medicinal Administration,
& Institute of Translational Medicine, Faculty of Health Sciences, University of
Macau, Macao SAR, China; Centre for Cognitive and Brain Sciences, University of
Macau, Macao SAR, China; Institute of Advanced Studies in Humanities and Social
Sciences, University of Macau, Macao SAR, China.
(2)College of Education for the Future, Beijing Normal University, Zhuhai,
Guangdong province, China.
Sciences, University of Macau, Macao SAR, China; Center for Cognition and Brain
Disorders, the Affiliated Hospital, Institutes of Psychological Sciences,
Hangzhou Normal University, Hangzhou,China.
(4)School of Nursing, Hong Kong Polytechnic University, Hong Kong SAR, China.
(5)Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital,
University of Melbourne, Richmond, Victoria, Australia.
(6)Faculty of Health and Life Sciences, De Montfort University, Leicester, UK.
(7)The National Clinical Research Center for Mental Disorders & Beijing Key
Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced
Innovation Center for Human Brain Protection, Capital Medical University,
Beijing, China. Electronic address: zqe81@126.com.

Sciences, University of Macau, Macao SAR, China. Electronic address:
xyutly@gmail.com.
The coronavirus disease 2019 (COVID-19) and Severe Acute Respiratory Syndrome
(SARS) are associated with various psychiatric comorbidities. This is a
systematic review and meta-analysis comparing the prevalence of psychiatric
comorbidities in all subpopulations during the SARS and COVID-19 epidemics. A
systematic literature search was conducted in major international (PubMed,
EMBASE, Web of Science, PsycINFO) and Chinese (China National Knowledge Internet
[CNKI] and Wanfang) databases to identify studies reporting prevalence of
psychiatric comorbidities in all subpopulations during the SARS and COVID-19
epidemics. Data analyses were conducted using the Comprehensive Meta-Analysis
Version 2.0 (CMA V2.0). Eighty-two studies involving 96,100 participants were
included. The overall prevalence of depressive symptoms (depression
hereinafter), anxiety symptoms (anxiety hereinafter), stress, distress, insomnia
symptoms, post-traumatic stress symptoms (PTSS) and poor mental health during
the COVID-19 epidemic were 23.9% (95% CI: 18.4%-30.3%), 23.4% (95% CI:
19.9%-27.3%), 14.2% (95% CI: 8.4%-22.9%), 16.0% (95% CI: 8.4%-28.5%), 26.5% (95%
CI: 19.1%-35.5%), 24.9% (95% CI: 11.0%-46.8%), and 19.9% (95% CI: 11.7%-31.9%),
respectively. Prevalence of poor mental health was higher in general populations
than in health professionals (29.0% vs. 11.6%; Q=10.99, p=0.001). The prevalence
of depression, anxiety, PTSS and poor mental health were similar between SARS
and COVID-19 epidemics (all p values>0.05). Psychiatric comorbidities were
common in different subpopulations during both the SARS and COVID-19 epidemics.
Considering the negative impact of psychiatric comorbidities on health and
wellbeing, timely screening and appropriate interventions for psychiatric
comorbidities should be conducted for subpopulations affected by such serious
epidemics.
DOI: 10.1016/j.jad.2021.03.016
PMCID: PMC7948672
Conflict of interest statement: There is no conflict of interest related to the
topic of this manuscript.
20. PLoS One. 2021 Mar 10;16(3):e0246454. doi: 10.1371/journal.pone.0246454.
eCollection 2021.
Prevalence of depression, anxiety and post-traumatic stress disorder in health
care workers during the COVID-19 pandemic: A systematic review and
meta-analysis.
Li Y(1), Scherer N(1), Felix L(1), Kuper H(1).
Author information:
(1)International Centre for Evidence in Disability, London School of Hygiene &
Tropical Medicine, London, United Kingdom.
OBJECTIVE: The COVID-19 pandemic has placed health care workers under
psychological stress. Previous reviews show a high prevalence of mental
disorders among health care workers, but these need updating and inclusion of
studies written in Chinese. The aim of this systematic review and meta-analysis
was to provide updated prevalence estimates for depression, anxiety and
post-traumatic stress disorder (PTSD) among health care workers during the
COVID-19 pandemic, benefitting from the inclusion of studies published in

Chinese.
METHODS: Systematic search of EMBASE, MEDLINE, PsycINFO, Global Health, Web of
Science, CINAHL, Google Scholar and the Chinese databases SinoMed, WanfangMed,
CNKI and CQVIP, for studies conducted between December 2019 and August 2020 on
the prevalence of depression, anxiety and PTSD in health care workers during the
COVID-19 pandemic. Studies published in both English and Chinese were included.
RESULTS: Data on the prevalence of moderate depression, anxiety and PTSD was
pooled across 65 studies involving 97,333 health care workers across 21
countries. The pooled prevalence of depression was 21.7% (95% CI, 18.3%-25.2%),
of anxiety 22.1% (95% CI, 18.2%-26.3%), and of PTSD 21.5% (95% CI, 10.5%-34.9%).
Prevalence estimates are also provided for a mild classification of each
disorder. Pooled prevalence estimates of depression and anxiety were highest in
studies conducted in the Middle-East (34.6%; 28.9%). Subgroup and
meta-regression analyses were conducted across covariates, including sampling
method and outcome measure.
CONCLUSIONS: This systematic review and meta-analysis has identified a high
prevalence of moderate depression, anxiety and PTSD among health care workers
during the COVID-19 pandemic. Appropriate support is urgently needed. The
response would benefit from additional research on which interventions are
effective at mitigating these risks.
DOI: 10.1371/journal.pone.0246454
PMCID: PMC7946321
Conflict of interest statement: The authors have declared that no competing
interests exist.
21. BMJ Open. 2021 Sep 21;11(9):e054528. doi: 10.1136/bmjopen-2021-054528.

Anxiety and depression among healthcare workers during the COVID-19 pandemic: a
systematic umbrella review of the global evidence.
Fernandez R(1)(2)(3), Sikhosana N(2)(3), Green H(2)(3), Halcomb EJ(4)(2)(5),
Middleton R(4)(2)(5), Alananzeh I(4), Trakis S(2), Moxham L(4)(2)(3)(5).
Author information:
(1)School of Nursing, Faculty of Science, Medicine and Health, University of
Wollongong, Wollongong, New South Wales, Australia ritin@uow.edu.au.
(2)St George Hospital, South Eastern Sydney Local Health District, Kogarah, New
South Wales, Australia.
(3)Centre for Evidence based Initiatives in Health Care: A JBI Centre of
Excellence, University of Wollongong, Wollongong, New South Wales, Australia.
(4)School of Nursing, Faculty of Science, Medicine and Health, University of
Wollongong, Wollongong, New South Wales, Australia.
(5)Illawarra Health and Medical Research Institute (IHMRI), Wollongong, New
South Wales, Australia.
OBJECTIVES: To summarise the evidence relating to the prevalence of anxiety and
depression among healthcare workers (HCWs) during the COVID-19 pandemic.
DESIGN: An umbrella review of systematic reviews was undertaken using the Joanna
Briggs Institute (JBI) methods.
DATA SOURCES: The Cochrane database of systematic reviews, JBI Evidence
Synthesis, MEDLINE, Web of Science, PsycINFO, Embase and CINAHL were searched in
March 2021 for reviews published in English.
ELIGIBILITY CRITERIA: Systematic reviews reporting the prevalence of anxiety and
depression among HCWs during the COVID-19 pandemic. Two researchers screened
each abstract and independently reviewed full text articles. Study quality was
assessed using the JBI critical appraisal tool for systematic reviews, and the
degree of overlap in primary studies was calculated.
RESULTS: Ten systematic reviews (100 unique studies), including 169 157 HCWs
from 35 countries were included. The prevalence of anxiety among all HCWs ranged
from 22.2% (95% CI 21.3% to 23.1%) to 33.0% (95% CI 31.9% to 34.1%). The
prevalence of anxiety among physicians (n=5820) was reported to be between 17%
and 19.8% and for nurses (n=14 938) between 22.8% and 27%. The prevalence of
depression among all HCWs ranged from 17.9% (95% CI 17.1% to 18.8%) to 36% (95%
CI 34.9% to 37.1%). The prevalence of depression among physicians (n=643) and
nurses (n=8063) was reported to be 40.4% and 28%, respectively.
CONCLUSIONS: There is wide variation evident in the presence of anxiety and
depression among HCWs. In particular, the prevalence of depression among
physicians was high. Strategies to reduce the incidence of anxiety and
depression are urgently required.
PROSPERO REGISTRATION NUMBER: CRD42021238960.
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No
commercial re-use. See rights and permissions. Published by BMJ.
DOI: 10.1136/bmjopen-2021-054528
PMCID: PMC8458002
Conflict of interest statement: Competing interests: None declared.
22. Int J Environ Res Public Health. 2021 Jun 17;18(12):6528. doi:
10.3390/ijerph18126528.
Psychological Effects of Home Confinement and Social Distancing Derived from
COVID-19 in the General Population-A Systematic Review.
Rodríguez-Fernández P(1), González-Santos J(1), Santamaría-Peláez M(1),
Soto-Cámara R(1), Sánchez-González E(2), González-Bernal JJ(1).

Author information:
(1)Department of Health Sciences, University of Burgos, 09001 Burgos, Spain.
(2)Department of Health Sciences, University of Jan Kochanowski, 25-369 Kielce,
Poland.
(1) Background: Home confinement and social distancing are two of the main
public health measures to curb the spread of SARS-Cov-2, which can have harmful
consequences on people's mental health. This systematic review aims to identify
the best available scientific evidence on the impact that home confinement and
social distancing, derived from the SARS-CoV-2 pandemic, have had on the mental
health of the general population in terms of depression, stress and anxiety. (2)
Methods: A systematic search was conducted on PubMed, Scopus, Web of Science and
ScienceDirect between 2 January 2021 and 7 January 2021, in accordance with the
recommendations of the PRISMA Declaration. The selection of studies and the
evaluation of their methodological quality were performed in pairs,
independently and blindly, based on predetermined eligibility criteria. (3)
Results: The 26 investigations reviewed were developed in different regions and
countries. Factors that are associated with poor mental health were female
gender, young ages, having no income and suffering from a previous psychiatric
illness. Inadequate management of the pandemic by authorities and a lack or
excess of information also contributed to worse mental health. (4) Conclusions:
There are groups of people more likely to suffer higher levels of anxiety,
depression and stress during the restrictive measures derived from COVID-19.
DOI: 10.3390/ijerph18126528
PMCID: PMC8296481

23. Acta Med Indones. 2021 Jul;53(3):352-359.
The Role of Online Psychotherapy in COVID-19: An Evidence Based Clinical Review.
Shatri H(1), Prabu OG, Tetrasiwi EN, Faisal E, Putranto R, Ismail RI.
Author information:
(1)Division of Psychosomatic and Palliative, Department of Internal Medicine,
Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital,
Jakarta, Indonesia. hshatri@yahoo.com.
BACKGROUND: COVID-19 is an infectious disease that is easily widespread and has
clinical manifestations as mild, moderate, or severe disease. COVID-19 patients
are required to be isolated during treatment to reduce transmission. This can
cause anxiety and depression, which in turn worsens the patient's illness.
Providing supportive psychotherapy can help provide a feeling of safety, comfort
and calm for patients. The choice of method in providing supportive
psychotherapy can be done online/teleconsultation or internet-based. This
clinical review aims to determine the effect of online teleconsultation or
internet-based psychotherapy on COVID-19 patients.
METHODS: A systematic search was performed using online databases, such as
PubMed, Cochrane, EBSCO/CINAHL and ProQuest. The identified articles were
screened using eligibility criteria. There were 2 studies (Zhou et al, and Wei
et al) which were analyzed critically using the Newcastle Ottawa Scale.
RESULTS: Both studies showed that management of psychotherapy through
teleconsultation or internet-based on COVID-19 patients can help relieve the
patient's psychological symptoms. Zhou et al studied 63 suspected COVID-19 with
23.8% (n = 15) having a Hospital Anxiety Depression Scale (HADS) score of 8 or
more. There was a significant decrease in HADS-A nxiety (HADS-A) scores (p
<0.01) and HADS-Depression (HADS-D) scores (p <0.01) in 15 patients, and from

the overall HADS scores (p < 0.01). Wei et al. Showed 17-HAMD and HAMA scores in
the online psychological intervention group also showed a significant reduction
in symptoms of depression and anxiety compared to controls.
CONCLUSION: Psychotherapy through online teleconsultation or internet-based on
COVID-19 patients can help relieve symptoms of anxiety and depression and
teleconsultation and also effective in dealing with psychological complications
in patients with COVID-19.
24. Sports Med. 2021 Aug;51(8):1771-1783. doi: 10.1007/s40279-021-01468-z. Epub 2021
Apr 22.
Is Physical Activity Associated with Less Depression and Anxiety During the
COVID-19 Pandemic? A Rapid Systematic Review.
Wolf S(1)(2), Seiffer B(3)(4), Zeibig JM(3)(4), Welkerling J(3)(4), Brokmeier
L(5), Atrott B(3)(4), Ehring T(6), Schuch FB(7).
Author information:
(1)Department of Psychology, Institute of Clinical Psychology and Psychotherapy,
University of Tuebingen, Tuebingen, Germany. sebastian.wolf@uni-tuebingen.de.
(2)Institute of Sport Science, Department of Education & Health Research,
University of Tuebingen, Tuebingen, Germany. sebastian.wolf@uni-tuebingen.de.
(3)Department of Psychology, Institute of Clinical Psychology and Psychotherapy,
University of Tuebingen, Tuebingen, Germany.
(4)Institute of Sport Science, Department of Education & Health Research,
University of Tuebingen, Tuebingen, Germany.
(5)Mannheim Institute of Public Health, Mannheim Medical Faculty, University of
Heidelberg, Mannheim, Germany.

(6)Department of Psychology, LMU Munich, Munich, Germany.
(7)Department of Sports Methods and Techniques, Federal University of Santa
Maria, Santa Maria, Brazil.
BACKGROUND: The Covid-19 pandemic is affecting the entire world population.
During the first spread, most governments have implemented quarantine and strict
social distancing procedures. Similar measures during recent pandemics resulted
in an increase in post-traumatic stress, anxiety and depression symptoms. The
development of novel interventions to mitigate the mental health burden are of
utmost importance.
OBJECTIVE: In this rapid review, we aimed to provide a systematic overview of
the literature with regard to associations between physical activity (PA) and
depression and anxiety during the COVID-19 pandemic.
DATA SOURCE: We searched major databases (PubMed, EMBASE, SPORTDiscus, and Web
of Science) and preprint servers (MedRxiv, SportRxiv, ResearchGate, and Google
Scholar), for relevant papers up to 25/07/2020.
STUDY ELIGIBILITY CRITERIA: We included observational studies with
cross-sectional and longitudinal designs. To qualify for inclusion in the
review, studies must have tested the association of PA with depression or
anxiety, using linear or logistic regressions. Depression and anxiety must have
been assessed using validated rating scales.
STUDY APPRAISAL AND SYNTHESIS METHODS: Effect sizes were represented by fully
adjusted standardized betas and odds ratios (OR) alongside 95% confidence
intervals (CI). In case standardized effects could not be obtained,
unstandardized effects were presented and indicated.
RESULTS: We identified a total of 21 observational studies (4 longitudinal, 1
cross-sectional with retrospective analysis, and 16 cross-sectional), including
information of 42,293 (age 6-70 years, median female = 68%) participants from
five continents. The early evidence suggests that people who performed PA on a
regular basis with higher volume and frequency and kept the PA routines stable,
showed less symptoms of depression and anxiety. For instance, those reporting a
higher total time spent in moderate to vigorous PA had 12-32% lower chances of
presenting depressive symptoms and 15-34% of presenting anxiety.
CONCLUSION: Performing PA during Covid-19 is associated with less depression and
anxiety. To maintain PA routines during Covid-19, specific volitional and
motivational skills might be paramount to overcome Covid-19 specific barriers.
Particularly, web-based technologies could be an accessible way to increase
motivation and volition for PA and maintain daily PA routines.
© 2021. The Author(s).
DOI: 10.1007/s40279-021-01468-z
PMCID: PMC8060908
Conflict of interest statement: All authors declare that they have no conflict
of interest.
25. Lancet. 2021 Nov 6;398(10312):1700-1712. doi: 10.1016/S0140-6736(21)02143-7.
Epub 2021 Oct 8.
Global prevalence and burden of depressive and anxiety disorders in 204
countries and territories in 2020 due to the COVID-19 pandemic.
COVID-19 Mental Disorders Collaborators.
Collaborators: Santomauro DF, Mantilla Herrera AM, Shadid J, Zheng P, Ashbaugh
C, Pigott DM, Abbafati C, Adolph C, Amlag JO, Aravkin AY, Bang-Jensen BL,
Bertolacci GJ, Bloom SS, Castellano R, Castro E, Chakrabarti S, Chattopadhyay J,
Cogen RM, Collins JK, Dai X, Dangel WJ, Dapper C, Deen A, Erickson M, Ewald SB,
Flaxman AD, Frostad JJ, Fullman N, Giles JR, Giref AZ, Guo G, He J, Helak M,
Hulland EN, Idrisov B, Lindstrom A, Linebarger E, Lotufo PA, Lozano R, Magistro
B, Malta DC, Månsson JC, Marinho F, Mokdad AH, Monasta L, Naik P, Nomura S,
O'Halloran JK, Ostroff SM, Pasovic M, Penberthy L, Reiner RC Jr, Reinke G,
Ribeiro ALP, Sholokhov A, Sorensen RJD, Varavikova E, Vo AT, Walcott R, Watson
S, Wiysonge CS, Zigler B, Hay SI, Vos T, Murray CJL, Whiteford HA, Ferrari AJ.
Comment in
Lancet. 2021 Nov 6;398(10312):1665-1666.
BACKGROUND: Before 2020, mental disorders were leading causes of the global
health-related burden, with depressive and anxiety disorders being leading
contributors to this burden. The emergence of the COVID-19 pandemic has created
an environment where many determinants of poor mental health are exacerbated.
The need for up-to-date information on the mental health impacts of COVID-19 in
a way that informs health system responses is imperative. In this study, we
aimed to quantify the impact of the COVID-19 pandemic on the prevalence and
burden of major depressive disorder and anxiety disorders globally in 2020.
METHODS: We conducted a systematic review of data reporting the prevalence of
major depressive disorder and anxiety disorders during the COVID-19 pandemic and
published between Jan 1, 2020, and Jan 29, 2021. We searched PubMed, Google
Scholar, preprint servers, grey literature sources, and consulted experts.
Eligible studies reported prevalence of depressive or anxiety disorders that
were representative of the general population during the COVID-19 pandemic and
had a pre-pandemic baseline. We used the assembled data in a meta-regression to
estimate change in the prevalence of major depressive disorder and anxiety
disorders between pre-pandemic and mid-pandemic (using periods as defined by
each study) via COVID-19 impact indicators (human mobility, daily SARS-CoV-2
infection rate, and daily excess mortality rate). We then used this model to
estimate the change from pre-pandemic prevalence (estimated using Disease
Modelling Meta-Regression version 2.1 [known as DisMod-MR 2.1]) by age, sex, and
location. We used final prevalence estimates and disability weights to estimate

years lived with disability and disability-adjusted life-years (DALYs) for major
depressive disorder and anxiety disorders.
FINDINGS: We identified 5683 unique data sources, of which 48 met inclusion
criteria (46 studies met criteria for major depressive disorder and 27 for
anxiety disorders). Two COVID-19 impact indicators, specifically daily
SARS-CoV-2 infection rates and reductions in human mobility, were associated
with increased prevalence of major depressive disorder (regression coefficient
[B] 0·9 [95% uncertainty interval 0·1 to 1·8; p=0·029] for human mobility, 18·1
[7·9 to 28·3; p=0·0005] for daily SARS-CoV-2 infection) and anxiety disorders
(0·9 [0·1 to 1·7; p=0·022] and 13·8 [10·7 to 17·0; p<0·0001]. Females were
affected more by the pandemic than males (B 0·1 [0·1 to 0·2; p=0·0001] for major
depressive disorder, 0·1 [0·1 to 0·2; p=0·0001] for anxiety disorders) and
younger age groups were more affected than older age groups (-0·007 [-0·009 to
-0·006; p=0·0001] for major depressive disorder, -0·003 [-0·005 to -0·002;
p=0·0001] for anxiety disorders). We estimated that the locations hit hardest by
the pandemic in 2020, as measured with decreased human mobility and daily
SARS-CoV-2 infection rate, had the greatest increases in prevalence of major
depressive disorder and anxiety disorders. We estimated an additional 53·2
million (44·8 to 62·9) cases of major depressive disorder globally (an increase
of 27·6% [25·1 to 30·3]) due to the COVID-19 pandemic, such that the total
prevalence was 3152·9 cases (2722·5 to 3654·5) per 100 000 population. We also
estimated an additional 76·2 million (64·3 to 90·6) cases of anxiety disorders
globally (an increase of 25·6% [23·2 to 28·0]), such that the total prevalence
was 4802·4 cases (4108·2 to 5588·6) per 100 000 population. Altogether, major
depressive disorder caused 49·4 million (33·6 to 68·7) DALYs and anxiety
disorders caused 44·5 million (30·2 to 62·5) DALYs globally in 2020.
INTERPRETATION: This pandemic has created an increased urgency to strengthen
mental health systems in most countries. Mitigation strategies could incorporate
ways to promote mental wellbeing and target determinants of poor mental health
and interventions to treat those with a mental disorder. Taking no action to
address the burden of major depressive disorder and anxiety disorders should not
be an option.
FUNDING: Queensland Health, National Health and Medical Research Council, and
the Bill and Melinda Gates Foundation.
Copyright © 2021 The Author(s). Published by Elsevier Ltd. This is an Open
Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All
rights reserved.
DOI: 10.1016/S0140-6736(21)02143-7
PMCID: PMC8500697
Conflict of interest statement: Declaration of interests C Adolph reports
support from the Benifcus Foundation. A Flaxman holds stock in Agathos, and
consults and advises Janssen, SwissRe, Sanofi, and Merck for Mothers on
simulation modeling, outside of the submitted work. S Nomura reports support
from the Ministry of Education, Culture, Sports, Science and Technology of
Japan. All other authors declare no competing interests.
26. J Affect Disord. 2021 Sep 1;292:172-188. doi: 10.1016/j.jad.2021.05.060. Epub
2021 Jun 2.
A living systematic review of the psychological problems in people suffering
from COVID-19.
Dong F(1), Liu HL(2), Dai N(1), Yang M(1), Liu JP(3).
Author information:
(1)Center for Evidence-Based Chinese Medicine, Beijing University of Chinese
Medicine, Beijing, China; School of Traditional Chinese Medicine, Beijing

University of Chinese Medicine, Beijing, China.
(2)Gastroenterology Department, Guang'anmen Hospital, China Academy of Chinese
Medicine Sciences, Beijing, China.
(3)Center for Evidence-Based Chinese Medicine, Beijing University of Chinese
Medicine, Beijing, China; Institute for Excellence in Evidence-Based Chinese
Medicine, Beijing University of Chinese Medicine, Beijing, China. Electronic
address: Liujp@bucm.edu.cn.
OBJECTIVES: We aimed to investigate the psychological problems on people
infected with SARS-CoV-2 during the pandemic.
METHODS: In this living systematic review and meta-analyses, we searched seven
electronic databases for cross-sectional studies and longitudinal studies on
psychological problems on COVID-19 patients from Jan 1, 2020 to Oct 7, 2020. The
primary outcome was prevalence of various psychological problems such as
anxiety, depression, stress, insomnia, somatization, and fear. We pooled data
for prevalence with their 95% confidence interval (CI) using random effect
models and assessed the study quality based on the 11-item checklist recommended
by the Agency for Healthcare Research and Quality.
RESULTS: Fourty-four studies, including studies from China(35), Italy(2),
Iran(2), India(1), Korea(1), Ecuador(1), Switzerland(1), Germany(1), were
identified by comprising a total of 8587 completed questionnaires and 38 studies
for meta-analyses. The prevalence of anxiety, depression, post-traumatic stress
disorder(PTSD), insomnia, somatization, and fear in patients with COVID-19 was
16.6% (10.1%-23.1%), 37.7% (29.3%-46.2%), 41.5% (9.3%-73.7%), 68.3%
(48.6%-88.0%), 36.5% (20.2%-52.8%), 47.6% (9.4%-85.7%), respectively. The
prevalence of anxiety, depression, and insomnia in severe COVID-19 patients
(intensive care unit inpatients) was higher than mild or clinically stable
COVID-19 patients.
LIMITATIONS: A significant degree of heterogeneity in terms of populations,
sampling methods, scales was noted across studies.
CONCLUSIONS: There existed high proportions of COVID-19 patients with

psychological problem. The prevalence of psychological problems was closely
related to the patients themselves, their surroundings and social support. It is
imperative to provide ontime psychological care service for COVID-19 patients
and to follow-up them for a longer period.
Copyright © 2021. Published by Elsevier B.V.
DOI: 10.1016/j.jad.2021.05.060
PMCID: PMC8169237
Conflict of interest statement: All authors declare that they have no conflict
of interests.
27. Int J Environ Res Public Health. 2021 Oct 10;18(20):10604. doi:
10.3390/ijerph182010604.
Mental Health during the COVID-19 Crisis in Africa: A Systematic Review and
Meta-Analysis.
Chen J(1), Farah N(2), Dong RK(3), Chen RZ(4), Xu W(5), Yin J(6), Chen BZ(4),
Delios AY(7), Miller S(1), Wan X(8), Ye W(9), Zhang SX(7)(10).
Author information:
(1)College of Business, Oregon State University, Corvallis, OR 97330, USA.
(2)College of Business and Analytics, Southern Illinois University Carbondale,
Carbondale, IL 62901, USA.
(3)Business School, University of South Australia, Adelaide, SA 5001, Australia.
(4)Crescent Valley High School, Corvallis, OR 97330, USA.
(5)International Business and Management Department, Nottingham University

Business School China, University of Nottingham Ningbo China, Ningbo 315100,
China.
(6)School of Humanities, Southeast University, Nanjing 211189, China.
(7)Department of Psychology, University of Adelaide, Adelaide, SA 5001,
Australia.
(8)School of Economics and Management, Tongji University, Shanghai 200092,
China.
(9)Department of Business Administration, School of Management, Jinan
University, Guangzhou 510632, China.
(10)Faculty of Professions, Entrepreneurship, Commercialization and Innovation
Center, University of Adelaide, Adelaide, SA 5005, Australia.
We aim to provide a systematic review and meta-analysis of the prevalence rates
of mental health symptoms among major African populations during the COVID-19
pandemic. We include articles from PubMed, Embase, Web of Science, PsycINFO, and
medRxiv between 1 February 2020 and 6 February 2021, and pooled data using
random-effects meta-analyses. We identify 28 studies and 32 independent samples
from 12 African countries with a total of 15,071 participants. The pooled
prevalence of anxiety was 37% in 27 studies, of depression was 45% in 24
studies, and of insomnia was 28% in 9 studies. The pooled prevalence rates of
anxiety, depression, and insomnia in North Africa (44%, 55%, and 31%,
respectively) are higher than those in Sub-Saharan Africa (31%, 30%, and 24%,
respectively). We find (a) a scarcity of studies in several African countries
with a high number of COVID-19 cases; (b) high heterogeneity among the studies;
(c) the extent and pattern of prevalence of mental health symptoms in Africa is
high and differs from elsewhere-more African adults suffer from depression
rather than anxiety and insomnia during COVID 19 compared to adult populations
in other countries/regions. Hence, our findings carry crucial implications and
impact future research to enable evidence-based medicine in Africa.
DOI: 10.3390/ijerph182010604
PMCID: PMC8536091
28. J Formos Med Assoc. 2021 Jun;120(6):1296-1304. doi: 10.1016/j.jfma.2021.01.023.
Epub 2021 Feb 1.
Mental health among healthcare personnel during COVID-19 in Asia: A systematic
review.
Thatrimontrichai A(1), Weber DJ(2), Apisarnthanarak A(3).
Author information:
(1)Division of Neonatology, Department of Pediatrics, Faculty of Medicine,
Prince of Songkla University, Songkhla, Thailand.
(2)Division of Infectious Diseases, University of North Carolina, Chapel Hill,
NC, United States.
(3)Division of Infectious Diseases, Department of Medicine, Thammasat University
Hospital, Pratumthani, Thailand. Electronic address: anapisarn@yahoo.com.
The COVID-19 pandemic has been associated with an insidious wave of
psychological stress among healthcare personnel (HCP) in Asia. Mental
exhaustion, burnout, fear, depression, anxiety, insomnia, and psychological
stress among HCPs have intensified a daunting challenge during the COVID-19
pandemic. The consequences of such stress may negatively impact patient and HCP
safety. This review article reports the associations of mental health status
attributed to the COVID-19 pandemic among HCP and their impact on patient
safety, and infection prevention and control practices during pandemics.

Copyright © 2021 Formosan Medical Association. Published by Elsevier B.V. All
rights reserved.
DOI: 10.1016/j.jfma.2021.01.023
Conflict of interest statement: Declaration of competing interest The authors
have no conflicts of interest relevant to this article.

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1. Brain Behav Immun. 2020 Aug;88:901-907. doi: 10.1016/j.bbi.2020.05.026.

Prevalence of depression, anxiety, and insomnia among healthcare workers during

the COVID-19 pandemic: A systematic review and meta-analysis.

(1)Dept of Psychiatry, Imperial College London, London, United Kingdom; West

London NHS Trust, London, United Kingdom. Electronic address:

(2)National and Kapodistrian University of Athens, Athens, Greece.

(3)National and Kapodistrian University of Athens, Athens, Greece; Pulmonary and

Respiratory Failure Department, First ICU, Evaggelismos Hospital. Athens,

Brain Behav Immun. 2021 Feb;92:247.

J Occup Environ Med. 2020 Nov;62(11):e677-e678.

Brain Behav Immun. 2021 Feb;92:205-206.

BACKGROUND: COVID-19 pandemic has the potential to significantly affect the

crisis. It is, therefore, an immediate priority to monitor rates of mood, sleep

inform tailored interventions. The aim of this review is to synthesize and

analyze existing evidence on the prevalence of depression, anxiety and insomnia

METHODS: A systematic search of literature databases was conducted up to April

17th, 2020. Two reviewers independently assessed full-text articles according to

data pooled using random-effects meta-analyses to estimate the prevalence of

specific mental health problems. The review protocol is registered in PROSPERO

and is available online.

of 33,062 participants. Anxiety was assessed in 12 studies, with a pooled

prevalence of 23·2% and depression in 10 studies, with a prevalence rate of

22·8%. A subgroup analysis revealed gender and occupational differences with

at 38·9% across 5 studies.

INTERPRETATION: Early evidence suggests that a considerable proportion of HCWs

Copyright © 2020 Elsevier Inc. All rights reserved.

PMID: 32437915 [Indexed for MEDLINE]

Conflict of interest statement: SP and PK report grants and personal fees

2. Psychiatry Res. 2020 Sep;291:113190. doi: 10.1016/j.psychres.2020.113190. Epub

medical staff and general public - A systematic review and meta-analysis.

Luo M(1), Guo L(2), Yu M(3), Jiang W(4), Wang H(5).

(1)Department of Anesthesiology, The 965(th) Hospital of the Joint Logistic

Electronic address: 2861248954@qq.com.

(2)Department of Psychology, 96605 Army Hospital, Jilin, 134001 China.

Electronic address: 854755750@qq.com.

(3)Department of Ophthalmology, The 965(th) Hospital of the Joint Logistic

Electronic address: 55198003@qq.com.

(4)Department of Disease Control, The 965(th) Hospital of the Joint Logistic

(5)Department of Anesthesiology, Daping Hospital, Army Medical University,

Chongqing, 400042 China. Electronic address: 710875839@qq.com.

The coronavirus disease 2019 (COVID-19) pandemic has caused enormous

psychological impact worldwide. We conducted a systematic review and

meta-analysis on the psychological and mental impact of COVID-19 among

risk published between 1 Nov 2019 to 25 May 2020. We conducted literature

higher-than-pooled prevalence among healthcare workers and the general public.

socioeconomic status, having high risks of contracting COVID-19, and social

isolation. Protective factors included having sufficient medical resources,

up-to-date and accurate information, and taking precautionary measures. In

conclusion, psychological interventions targeting high-risk populations with

heavy psychological distress are in urgent need.

Copyright © 2020 Elsevier B.V. All rights reserved.

PMID: 32563745 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest None.

3. Rev Esp Salud Publica. 2020 Jul 23;94:e202007088.

[Impact of SARS-CoV-2 (Covid-19) on the mental health of healthcare

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Huelva. Huelva. España.

(2)Escuela Superior de Salud. Universidade Atlântica. Lisboa. Portugal.

(3)Programa de Posgrado de Seguridad y Salud. Universidad Espíritu Santo.

(4)Consorcio de transporte sanitario onubense. Base en Centro de Salud de Isla

Cristina. Huelva. España.